Classification of Periodontal Diseases and Conditions

American Dental Association Classifications (ADA)

• The system developed by the American Dental Association classification
• System is primarily based on the severity of attachment loss. The clinician uses the clinical and radiographic data gathered and classifies the patient into one of the four Case Types.
• These Case Types are commonly required for insurance billing. In addition, the ADA provides treatment recommendations for each Case Type which is not part of this presentation.

American Dental Association Classifications (ADA)-1989

• Case Type I: Gingivitis
• Case Type II: Early Periodontitis
• Case Type III: Moderate Periodontitis
• Case Type IV: Advanced Periodontitis

ADA: Risk Management Series, diagnosis and Managing the Periodontal patient, 1986

American Academy of Periodontology (AAP)

• The American Academy of Periodontology classification system was established to identify distinct types of periodontal diseases by taking into consideration factors such as age of onset, clinical appearance, rate of disease progression, pathogenic microbial flora and systemic influences.

• The two major categories are Gingivitis and Periodontitis.

• Within each category there are specific types of diseases identified

                                                                                                                AAA 1989

Gingivitis Subdivisions

• Chronic Gingivitis
• Acute Necrotizing Ulcerative Gingivitis
• Gingivitis Associated with Systemic Conditions or Medications
• Hormone-Induced Gingival Inflammation
• Drug-Influenced Gingivitis
• Linear Gingival Erythema (LGE)
• Gingival Manifestations of Systemic Diseases and Mucocutaneous Lesions
• Bacterial, Viral or Fungal
• Blood Dyscrasias (for example Acute Monocytic Leukemia)
• Mucocutaneous Diseases (Lichen Planus, Cicatricial Pemphigoid)

Periodontitis Subdivisions

• Adult Periodontitis

• Early-Onset Periodontitis

Prepubertal

Juvenile Periodontitis

• Rapidly Progressive

• Periodontitis Associated with Systemic Diseases

• Necrotizing Ulcerative Periodontitis

• Refractory

AAP Classification

The American Academy of Periodontology has recently published changes in the
classification system for periodontal diseases

These changes are from the 1999 International Workshop for a Classification of Periodontal Diseases and Conditions.

Conditions. Highlights of the changes are as follows:

1. Addition of a section on "Gingival Diseases"
2. Replacement of "Adult Periodontitis" with "Chronic Periodontitis“
3. Replacement of "Early-Onset Periodontitis" with "Aggressive Periodontitis"
4. Elimination of a separate disease category for "Refractory Periodontitis"
5. Replacement of "Necrotizing Ulcerative Periodontitis" with "Necrotizing Periodontal Diseases"
6. Addition of a category on "Periodontal Abscess"
7. Addition of a category on "Periodontic-Endodontic Lesions"
8. Addition of a category on "Developmental or Acquired Deformities & Conditions"

                                                                                        AAP 1999

Classification of Gingival Diseases:

Non-Plaque induced gingival lesions

• Gingival diseases of specific bacterial origin
• Gingival diseases of viral origin
• Gingival diseases of fungal origin
• Gingival diseases of genetic origin
• Gingival manifestations of systemic conditions
• Traumatic lesions
• Foreign body reactions

Plaque induced gingival lesions

Acute Necrotizing Ulcerative Gingivitis

Classification of Periodontitis

1.    Chronic Periodontitis*

Localized

Generalized

2.    Aggressive Periodontitis

Localized

Generalized

3.    Periodontitis Associated with Systemic Diseases

4.    Necrotizing Periodontal Diseases

5.    Abscesses of the Periodontium

6.    Periodontal Diseases associated with Endodontic Lesions

7.    Developmental or Acquired Deformities and Conditions

*Can be further classified on basis of extent and severity